Indications for: CELEXA
Initially 20mg once daily; after ≥1 week may increase to 40mg once daily. Doses >40mg/day: not recommended. Elderly (>60yrs), hepatic impairment, CYP2C19 poor metabolizers, concomitant cimetidine or other CYP2C19 inhibitors: max 20mg/day. 3rd trimester pregnant women: consider tapering dose.
Concomitant pimozide, linezolid, IV methylene blue. During or within 14 days of MAOIs; do not start an MAOI during or within 14 days of citalopram.
Increased risk of suicidality.
Increased risk of suicidal thinking and behavior in children, adolescents and young adults; monitor for clinical worsening and unusual changes. Congenital long QT syndrome, bradycardia, hypokalemia, hypomagnesemia, recent MI, uncompensated heart failure, or concomitant drugs that prolong the QT interval: not recommended; monitor ECG if therapy is considered. Correct hypokalemia, hypomagnesemia before starting and periodically monitor. Bipolar disorder. History of seizures or mania/hypomania. ECT. Monitor for serotonin syndrome; discontinue if occurs. Angle-closure glaucoma. Hepatic or severe renal impairment (CrCl <20mL/min). Volume-depleted. Sexual dysfunction. Avoid abrupt cessation. Reevaluate periodically. Write ℞ for smallest practical amount. Elderly. Labor & delivery. Pregnancy: effects on neonates exposed in 3rd trimester (see full labeling). Nursing mothers: not recommended.
See Contraindications. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Avoid drugs that prolong QT interval including Class 1A (eg, quinidine, procainamide) or Class III antiarrhythmics (eg, amiodarone, sotalol), antipsychotics (eg, chlorpromazine, thioridazine), antibiotics (eg, gatifloxacin, moxifloxacin), and others (eg, pentamidine, methadone, levomethadyl acetate). Avoid alcohol. Increased risk of bleeding with NSAIDs, aspirin, warfarin, and others that affect coagulation. May be potentiated by cimetidine, lithium, potent inhibitors of CYP2C19 or CYP3A4 (eg, azole antifungals). May be antagonized by carbamazepine. Increases metoprolol levels.
Nausea, diarrhea, dry mouth, somnolence, insomnia, increased sweating, ejaculation disorder, rhinitis, agitation, fatigue, anxiety, anorexia, arthralgia, myalgia, hyponatremia (esp. elderly); dose-dependent QT prolongation.
Tabs—100; Soln—Contact supplier